Knee injuries are common among athletes and active individuals, and two of the most challenging injuries involve the anterior cruciate ligament (ACL) and cartilage defects. While ACL tears compromise knee stability, cartilage damage can cause pain, swelling, and long-term joint degeneration. In recent years, orthopedic surgeons have increasingly combined cartilage transplant procedures with ACL repair to improve outcomes for patients facing both injuries.

This blog explores why these procedures are combined, expected outcomes, rehabilitation, and what patients need to know before undergoing surgery.

Why Combine ACL Repair with Cartilage Transplant?

Treating ACL tears and cartilage defects simultaneously addresses both stability and joint integrity, which is critical for long-term knee health. The benefits include:

• Restoring Knee Stability

  ACL reconstruction stabilizes the knee, protecting the newly transplanted cartilage from abnormal stress that could lead to graft failure.

• Reducing Future Injury Risk

  Correcting both injuries in a single procedure lowers the chance of additional knee damage and cartilage deterioration.

• Enhancing Functional Recovery

  Patients regain strength, range of motion, and joint function more effectively when both injuries are addressed together.

• Improving Long-Term Outcomes

  Studies suggest that patients undergoing combined procedures often experience better pain relief, improved knee function, and delayed onset of osteoarthritis.

Understanding Cartilage Transplantation

Cartilage transplant procedures replace damaged cartilage with healthy tissue. There are two main approaches:

• Osteochondral Allograft (OCA)

  Uses donor cartilage and bone to repair large defects. Ideal for deep or complex cartilage injuries.

• Autologous Chondrocyte Implantation (ACI)

  Uses the patient’s own cartilage cells, harvested, cultured, and re-implanted. Typically used for smaller, focal defects.

The procedure can be performed simultaneously with ACL reconstruction or in staged surgeries, depending on the patient’s condition and the surgeon’s assessment.

Outcomes: What Patients Can Expect

Clinical studies and long-term follow-ups indicate positive results for patients undergoing combined ACL and cartilage procedures:

• Pain Relief

  Most patients report a significant reduction in pain after surgery, enabling easier movement and improved quality of life.

• Improved Function

  Activities of daily living, such as walking, climbing stairs, and bending the knee, become more comfortable.

• Return to Sports

  Athletes often resume sports, though timelines are longer than isolated ACL surgery due to cartilage healing requirements.

• Graft Survival

  When performed by skilled surgeons with proper rehabilitation, cartilage grafts show high long-term survival rates.

• Complications

  As with any surgery, risks include infection, stiffness, graft failure, or swelling. Careful patient selection and post-operative care reduce these risks significantly.

Rehabilitation After Combined Surgery

Recovery is crucial for the success of both ACL reconstruction and cartilage transplantation. Rehabilitation is typically structured in phases:

1. Phase 1 (0-6 Weeks)

   Focus on reducing swelling, regaining passive motion, and avoiding stress on the grafted cartilage.

2. Phase 2 (6-12 Weeks)

   Gradual weight-bearing, gentle strengthening of quadriceps, hamstrings, and hip muscles.

3. Phase 3 (3-6 Months)

   Advanced strengthening, balance exercises, and low-impact cardio are introduced.

4. Phase 4 (6-9 Months)

   Sport-specific training and functional drills, monitored for pain or instability.

5. Phase 5 (9-12 Months)

   Full return to competitive sports after ensuring stability, graft integrity, and adequate strength.

Patient adherence to rehabilitation protocols is essential. Premature stress on the knee can compromise graft survival, while insufficient activity may cause stiffness and delayed recovery.

Common Myths About Combined Surgery

• Recovery will be faster than isolated ACL surgery.

  Combined procedures often take longer due to cartilage healing requirements.

• Cartilage transplants last forever.

  While effective, outcomes vary depending on age, activity level, and rehabilitation compliance.

• I can resume sports immediately.

  Returning too early can compromise both the ACL graft and cartilage transplant, increasing the risk of re-injury.

Who Should Consider Combined Surgery?

Ideal candidates for combined ACL and cartilage repair include:

• Active individuals or athletes with ACL tears and focal cartilage defects
• Patients aiming to return to high-demand sports or physical activities
• Patients with minimal osteoarthritis or comorbidities that could affect healing

Consultation with an experienced orthopedic surgeon is necessary to determine candidacy and the best surgical approach.

Frequently Asked Questions

• Q1: How long is recovery?

  A: Full recovery usually takes 9-12 months, depending on graft size, patient age, and adherence to rehab.

• Q2: Can I return to sports?

  A: Yes, most patients can return to sports, but the timeline is longer than isolated ACL reconstruction.

• Q3: What are the risks?

  A: Risks include infection, stiffness, swelling, or graft failure, but these are minimized with careful surgical technique and proper rehabilitation.

• Q4: Will this prevent arthritis?

  A: Combined surgery reduces the risk of accelerated joint degeneration but does not guarantee complete prevention.

Conclusion

Combining cartilage transplantation with ACL repair provides a comprehensive solution for patients with complex knee injuries. By addressing both stability and cartilage health, patients experience less pain, improved function, and better long-term outcomes.

Success relies on careful patient selection, expert surgical technique, and disciplined rehabilitation. For athletes and active individuals facing ACL tears with cartilage damage, this combined approach offers a path to safe and effective recovery.

If you are experiencing knee pain or have been diagnosed with an ACL tear and cartilage defect, early consultation with an orthopedic specialist can help you plan the best treatment strategy for long-term knee health.